One out of five Americans smokes tobacco regularly. Even so, people are (or become) aware of the dangers that tobacco may pose (including lung cancer and high blood pressure) and take up the quest to end their addiction to tobacco. But the road is long, and not without pitfalls; the average smoker attempts to quit five times before permanent success. Use of an over-the-counter and/or prescription medication used during smoking cessation can double to triple the odds of success in quitting. These medications include:
- Nicotine replacement therapies (NRTs): These include patches, gum, lozenges, inhalers and nasal spray. NRTs decrease cravings and withdrawal symptoms, with the patch delivering a slow release of nicotine and the others providing a quicker release to the brain. Heavier smokers frequently find benefit from combining the patch with intermittent use of one of the others to decrease breakthrough cravings. Duration of therapy is usually about two months, with a gradual decrease in dose. NRTs should not be used during pregnancy as they may cause birth defects, and they should not be used in patients with unstable heart disease or within two weeks of a heart attack.
- Buproprion (Zyban, Wellbutrin): Initially developed as an anti-depressant, buproprion is thought to block tobacco’s access to nicotine receptors in the brain and it doubles the odds of quitting when compared to placebo. It is useful at decreasing the risk of weight gain and depression that frequently occurs with tobacco cessation. It can successfully be combined with NRTs for increased effectiveness, but it should not be used in patients with a history of seizure disorder or anorexia. Side effects may include trouble sleeping, jitteriness and dry mouth.
- Varenicline (Chantix): Varenicline is probably the most effective medication available, tripling the odds of quitting when compared to placebo. It works by blocking nicotine receptors in the brain. The medication is typically used for three months, and the urge to smoke usually diminishes by the second to third week. It cannot be combined with NRTs, and hasn’t been studied in combination with buproprion. Recent data suggests that varenicline may increase the risk of heart attack in smokers with underlying heart disease. Side effects may include nausea, headache, dreams and depression.
Quitting tobacco can be very difficult, be it the first time or the fifth time, and it is much more difficult to do it alone. At North Idaho Direct Primary Care, we are equipped to help those in the pursuit of smoking cessation. If you are a member of North Idaho Direct Primary Care and wish to stop smoking, contact our office to set up a consultation with Dr. Samuel. If you are not a member and would like to find out more about our practice, you can click here for further reading. If you found this article helpful, click here to sign up for our monthly newsletter.